Lindsay Edouard

Ensuring access to HPV vaccines through integrated services: a reproductive health perspective

In 2006, a quadrivalent human papillomavirus (HPV) vaccine was licensed, and another vaccine may be licensed soon. Little is known about the practical considerations involved in designing and implementing cervical cancer prevention programmes that include vaccination as a primary means of prevention. Although the vaccine may ultimately be indicated for both males and females, young girls, or girls and women aged 9-25 years, will be the initial candidates for the vaccine. This paper describes avenues for service delivery of HPV vaccines and critical information gaps that must be bridged in order to inform future sexual and reproductive health programming. It proposes the role that the sexual and reproductive health community, together with immunization and cancer control programmes, could have in supporting the introduction of HPV vaccines within the context of current health systems.

Targeting Access to Reproductive Health: Giving Contraception More Prominence and Using Indicators to Monitor Progress

Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by peoples preferences and choices and therefore firmly introduces a rights perspective into development discourse and serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health. Résumé Le besoin insatisfait de contraception représente un échec majeur dans la prestation de soins de santé génésique et mesure laccès aux services despacement et de limitation des naissances, qui est aussi influencé par des facteurs personnels, des partenaires, communautaires et du système de santé. Dans le contexte des objectifs du Millénaire pour le développement, la planification familiale a reçu moins dattention que la santé maternelle et la lutte contre les infections sexuellement transmissibles. Les activités entreprises pour corriger cette omission doivent garantir lutilisation dun indicateur du besoin insatisfait comme mesure de laccès aux services. Il faut aussi accroître la disponibilité de données sur le besoin insatisfait pour permettre les comparaisons nationales et faciliter la mobilisation de ressources. Le besoin insatisfait est un élément essentiel pour évaluer la proportion de femmes capables despacer et de limiter les naissances. Le besoin insatisfait de contraception est une mesure conditionnée par les préférences et les choix personnels et il introduit donc fermement une perspective des droits dans le discours sur le développement. Cest par conséquent un instrument précieux pour sensibiliser le dialogue politique. La nouvelle cible en matière de santé génésique et loccasion quelle offre daccorder suffisamment dattention au besoin insatisfait de contraception permettront lentrée dautres considérations capitales pour assurer un accès universel à la santé génésique. Resumen La necesidad insatisfecha de recibir anticonceptivos constituye un fracaso en la prestación de servicios de salud reproductiva y refleja la importancia de tener acceso a los servicios para espaciar y limitar partos, que también son afectados por factores personales, así como de la pareja, comunidad y sistema de salud. En el contexto de los Objetivos de Desarrollo del Milenio, se le ha dado muy poca atención a la planificación familiar en comparación con la salud materna y el control de las infecciones de transmisión sexual. A medida que se revalúa esta omisión, se deben dirigir esfuerzos hacia garantizar que un indicador de la necesidad insatisfecha sea utilizado como una medida del acceso a los servicios. La disponibilidad de datos sobre dicha necesidad también debe ampliarse para permitir comparaciones nacionales y facilitar la movilización de recursos. La necesidad insatisfecha es un elemento vital en el monitoreo de la proporción de mujeres con posibilidad de espaciar y limitar partos. La necesidad insatisfecha de anticoncepción es una medida condicionada por las preferencias y decisiones de las personas; por tanto, introduce firmemente una perspectiva de derechos en el debate del desarrollo y sirve como un instrumento importante para mejorar la sensibilidad del diálogo en políticas. La nueva meta de salud reproductiva y la oportunidad que ésta ofrece para prestar la atención adecuada a dicha necesidad permitirá que se tomen en cuenta otros factores vitales para garantizar acceso universal a la salud reproductiva.

The implementation of reproductive health programs: experiences, achievements and challenges

As a fundamental element of population strategies for international development, reproductive health has received much recognition since the International Conference on Population and Development held in Cairo in 1994. Nevertheless, much remains to be done to improve the understanding of the concept of reproductive health, support reproductive rights, operationalize reproductive healthcare within basic health services and promote a more conducive social, cultural and economic environment, especially for women and girls, to enable the attainment of reproductive health. Collaboration between governments and non‐governmental organizations will be crucial and obstetrician‐gynecologists have a unique role, through service provision, review of regulatory frameworks, education and advocacy, for the promotion of reproductive health.

The right to contraception and the wrongs of restrictive services

Rights come with responsibilities for individuals, service providers, and purveyors. The operationalization of the right to contraception, for universal access to a wide range of effective methods, necessitates very different but complementary interventions. A rights‐based approach should aim to respect, protect, and fulfill rights. The wishes of individuals concerning childbearing necessitate informed choice, access to services, and lack of prejudice. Equity should be addressed through the strengthening of health systems, especially primary health care, with emphasis on the needs of underserved populations. Official pronouncements on population issues necessitate commitments. A philosophy of rights is particularly useful for service implementation, including the introduction of new contraceptive methods, by addressing the responsibilities of duty bearers and the claims of right holders. With the rights to and overwhelming health benefits of contraception, it is imperative to reverse the wrongs of limited reproductive health services.

Progress towards the Millennium Development Goals: a long trek for reproductive health.

With only six years remaining to achieve the Millennium Development Goals in 2015, issues pertaining to universal access to reproductive health deserve more emphasis as part of current efforts in international health. The maternal health goal is the Millennium Development Goal with the most disappointing progress. Whereas much has been achieved globally for the utilization of family planning services, there are some geographical areas and subpopulations where progress is lacking. Health systems should be strengthened whilst addressing disparities. The rights and gender aspects of reproductive health have been fully documented, but equitable access and economic aspects should be considered in policy formulation and program implementation. Advocacy is needed for key players to leverage support, whereas efforts for accelerating progress should be sustainable in the long term.

Sexual and Reproductive Health at 2015 and Beyond: A Global Perspective

The International Conference on Population and Development and Millennium Development Goals propelled reproductive health into priorities for international development through declarations, statements, and frameworks. However, key indicators demonstrate that progress in both service provision and clinical outcomes has not been optimal, especially for certain disadvantaged groups. With the Sustainable Development Goals, efforts over the next two decades will focus on access to and quality of health services. Advocacy for mobilizing resources will be complemented by accountability, especially monitoring and evaluation, for utilization of these resources during the life cycle. Stakeholders should emphasize national commitments, with broad partnerships, to ensure long-term sustainability.

Challenges for Reproductive Health in the Attainment of the Millennium Development Goals

Universal access to reproductive health has become prominent in international development through its inclusion in the Millennium Development Goals. Although that specific goal focusing on maternal health might not be achieved by 2015, it is expected that the implementation of ongoing strategies and previous commitments for resource mobilization will lead to sustained efforts. More emphasis should be placed on addressing disparities and adopting a life-cycle approach to sexual and reproductive health.

The Role of Reproductive Health for Attainment of the Millennium Development Goals

Universal access to reproductive health services is a major aim of current efforts towards attaining the Millennium Development Goals, and reproductive rights and poverty reduction are crosscutting issues for this current focus of international development. Political statements should be complemented by financial commitments for mobilizing resources and the formulation of country-owned action plans. Upscaling services will necessitate strengthening health systems, integrating care, and building capacities. Policy makers, service providers, and stakeholders have responsibilities and duties to ensure that frameworks are available for the adequate provision of services. The implementation of multiple international development strategies currently constitutes a priority for reaching the targets by 2015.

Sexually transmitted infections: Key issues for clinical practice.

The Alliance for Womens Health identified sexually transmitted and reproductive tract infections (STIs/RTIs) other than HIV as a priority issue for discussion during its precongress workshop on access to care at the XVIII World Congress of Gynecology and Obstetrics which was held in Kuala Lumpur in November 2006. Annually there are 340 million new cases of gonorrhea syphilis chlamydia and trichomoniasis the four curable sexually transmitted infections besides the most prevalent viral ones such as herpes simplex virus type 2 and human papillomavirus. The measure of disability-adjusted life years (DALYs) for the burden of disease underestimates the impact of sexually transmitted and reproductive tract infections. For example the 3.3 million DALYs due to cervical cancer from the human papillomavirus are not included in the STI category whereas candidiasis and bacterial vaginosis which are the most common RTIs cause distressing symptoms which are not included in calculations of the burden of diseases. Stillbirth prematurity and congenital syphilis as well as infertility from chlamydia and gonorrhea are underestimated. With gender-based power inequalities women are more vulnerable to acquiring infection and furthermore their symptoms and signs of infection can remain hidden until irreversible damage has occurred. As the prevention and management of STIs/RTIs should be an integral part of reproductive health care obstetrician-gynecologists should initiate their management as part of a holistic approach to patient care. (excerpt)